| NPI | 1780827055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS CHEDIAK President 305-910-9170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL me61828) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL pt19963) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2009-05-25 |